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Determination of Predictors of Brain Injury in Very Preterm Infants - A Retrospective Cohort Study
Thangaraj Abiramalatha1, Usha Devi1, Suhas Nagaraj2
1Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Insights
Severe intraventricular hemorrhage (IVH), sepsis, prolonged ventilation, and small for gestational age (SGA) significantly increase the risk of preterm brain injury. Severe IVH is the most critical factor.
Area of Science:
- Neonatal Neurology
- Pediatric Neuroimaging
- Perinatal Medicine
Background:
- Etiological factors of brain injury in preterm infants remain inadequately understood despite extensive research.
- Identifying perinatal risk factors is crucial for preventing adverse neurological outcomes in premature neonates.
Purpose of the Study:
- To investigate perinatal risk factors associated with preterm brain injury.
- To quantify the strength of association between identified risk factors and brain injury in preterm infants.
Main Methods:
- Retrospective cohort study including infants born before 32 weeks' gestation.
- Brain injury assessed via magnetic resonance imaging (MRI) or cranial ultrasound (CUS) at term equivalent age.
- Significant brain injury defined by Kidokoro score ≥4 (MRI) or cystic periventricular leukomalacia (CUS).
Main Results:
- Of 698 infants, 48 experienced significant brain injury.
- Intraventricular hemorrhage (IVH) grade 3-4 showed a strong association (aOR 92.892).
- Culture-positive sepsis (aOR 4.162), prolonged ventilation (aOR 3.688), and small for gestational age (SGA) (aOR 2.645) were also significant risk factors.
Conclusions:
- Severe IVH, culture-positive sepsis, prolonged ventilation, and SGA are significant risk factors for preterm brain injury.
- Severe IVH emerged as the most potent contributing factor to brain injury in this cohort.
Background:
Despite decades of research, there is inadequate evidence on the etiological factors of brain injury in preterm infants.
Objective:
To study the perinatal risk factors for preterm brain injury and to assess their strength of association.
Methods:
In this retrospective cohort study, we included infants born at <32 weeks' gestation and had either magnetic resonance imaging (MRI) or cranial ultrasound (CUS) performed at term equivalent age. Significant brain injury was diagnosed based on Kidokoro global brain injury score was ≥4 in MRI or cystic periventricular leukomalacia in CUS.
Results:
Among the 698 infants, 48 had significant brain injury and 650 were taken as controls. In multiple logistic regression, intraventricular hemorrhage (IVH) grade 3-4 [adjusted odds ratio, 92.892 (19.495-442.619)], culture-positive sepsis [4.162 (1.729-10.021)], prolonged ventilation [3.688 (1.087-12.510)], and small for gestational age (SGA) [2.645 (1.181-5.924] were associated with greater risk of preterm brain injury.
Conclusion:
Severe IVH, culture-positive sepsis, prolonged ventilation and SGA were significant risk factors for preterm brain injury with severe IVH being the most significant contributing factor.
